Creating an Infection Prevention Program: What You Need to Know

A 2022 report by the U.S. Centers for Disease Control and Prevention (CDC) cites the unfortunate news that antimicrobial resistance is currently a leading cause of death worldwide. In the U.S., statistics predict that over 3 million Americans will likely develop an antimicrobial-resistant infection each year; in 2019, close to 49,000 Americans died from antibiotic resistant infection.

What is antimicrobial resistance and why does it happen?

When bacteria, fungi and other pathogens can’t be killed by antibiotics or antifungals developed to eliminate them, they are considered drug-resistant infections. Fewer prescriptions, careful use of antibiotics, better infection prevention measures, and quick isolation of infected patients are hailed as the reasons for the 18% decrease in deaths due to drug-resistant infections between 2012 and 2017.

However, the start of the COVID-19 pandemic reversed this decline in less than a year, with a 15% increase in healthcare-associated infections (HAIs) and deaths in 2020. Between March and October 2020, favorable conditions for HAIs spread quickly: 80% of patients hospitalized with COVID-19 received antibiotics. And there was a marked increase in the use of invasive medical devices, like ventilators and catheters, to treat very ill COVID patients.

The expansion of infection control programs in the U.S.

The American Hospital Association released the first standards for hospital infection control programs in 1968. These standards became part of the requirements for hospital accreditation, which helped speed the adoption of infection control practices through the 1970s.

In the early 1980s, outside factors made hospitals question the value and expense of infection control programs. A change in the way insurances reimbursed hospitals for patient care–introducing the diagnostic-related groups (DRG) payment system–did not include all the cost of care needed to treat HAIs. The HIV/AIDS crisis also started around the same time, increasing patient volume and the frequency of HAIs among patients with HIV.

Reform of the U.S. healthcare system in the 1990s further expanded the use of standardized infection control programs and certifications beyond hospitals. Home health providers, rehabilitation centers, long-term care facilities and free-standing surgical centers also incorporated infection control programs into their operations.

Findings from the SENIC study

In 1985, in response to the rising doubts about the benefits of infection control programs, the CDC released a report, the Study on the Efficacy of Nosocomial Infection Control Project (SENIC). SENIC examined the data from 1975 to 1976 of more than 339,000 medical records and infection control programs in 338 hospitals. The cost-benefit analysis of the study revealed when an infection control program reduced just 6% of a facility’s HAIs, the savings from the avoided HAIs offset the costs of the program.

The study also revealed some keys to success for infection control programs. Organizations that included the following in their infection control program could reduce their HAI rates by around 32%:

A facility-wide surveillance system that provides reporting back to staff who are clinically involved with a patient with a drug-resistant infection
An infection control team with a physician and an infection control professional for every 250 beds

Regulatory compliance and certification of infection control programs

Federal and state agencies closely regulate organizations that provide healthcare. For example, the Centers for Medicare & Medicaid Services (CMS) require hospitals and other healthcare facilities to follow national CDC standards for infection prevention and reporting.

While accreditation is not mandatory, it may provide a competitive advantage, enhance risk management, and improve patient safety. Accreditation may sometimes be required for a healthcare organization to qualify to do business with certain managed care plans or to purchase liability insurance at favorable rates. Achieving certification from one of the established accrediting bodies, such as the Joint Commission (TJC), Det Norske Veritas, Inc. (DNV), or the Healthcare Facilities Accreditation Program (HFAP), is viewed by the healthcare industry and the public as a sign of excellence.

Overview of developing an infection control program

Most healthcare organizations in the U.S. already have an infection control program in place. But the program may not be effective, or has been adversely impacted by recent staffing shortages, supply chain challenges and surges in patient volume from waves of COVID outbreaks. We see evidence of the impact of the pandemic on data reporting in the CDC data gaps for 2020. National statistics are unavailable for half of the 18 antimicrobial resistant infections that the CDC monitors nationally.

An older, but still relevant resource from Infection Control Today® gives a good overview of the aspects of an infection control program that should be re-examined periodically. A full assessment to upgrade an existing infection control program needs to include, among other things, a review of:

Staffing levels of infection control professionals
Previous surveillance data
History and reporting of adverse events
Data collection, analysis and monitoring of antibiotic utilization

Policies and precautions can be organized and reviewed based on transmission types:

Standard
Contact
Droplet
Airborne

Or by program component:

Surveillance
Isolation
Incidence investigation
Education and training
Environmental services

Here are links to additional resources about developing an infection prevention program.

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